Light Pollution and Sleep Questionnaire
This questionnaire is designed to assess links between light levels in the environment and sleep patterns, and is part of a study conducted by scientists at Trinity College Dublin and NUI Maynooth.  We greatly appreciate your time in completing the form.
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Please give the geographical are where you live
1
Describe the area in which you live:
Clear selection
2
Do you believe excessive lighting can adversely affect a person's health?
Clear selection
3
How strongly do you feel affected by excessive artifical lighting outside of your residence?
No effect
Severe problems
Clear selection
4
Exterior artifical light causes me to feel sleep loss or sleep deprivation
No effect
Highly affected
Clear selection
5
Exterior artifical light causes me to feel anxious
No effect
Highly affected
Clear selection
6
Exterior artifical light causes me to feel visual fatigue
No effect
Highly affected
Clear selection
6
Exterior artifical light causes me to feel depressed
No effect
Highly affected
Clear selection
8
Exterior artifical light causes me to feel weariness
No effect
Highly affected
Clear selection
9
Exterior artifical light causes me to feel other - please specify and rate 1-7 as above.
10
Please rate how bright you feel the area outside your residence is at night.
Pitch Black
Bright as day
Clear selection
11
Have you ever considered moving elsewhere because of the level of light outside your residence?
Clear selection
12
How do you rate that street lights contribute to excessive lighting in your area
None whatsoever
Highly excessive
Clear selection
13
How do you rate that car headlights contribute to excessive lighting in your area
None whatsoever
Highly excessive
Clear selection
14
How do you rate that light from other domestic premesis contribute to excessive lighting in your area
None whatsoever
Highly excessive
Clear selection
15
How do you rate that commercial premesis (eg. shop signs)  contribute to excessive lighting in your area
None whatsoever
Highly excessive
Clear selection
16
How do you rate that other factors contribute to excessive lighting in your area.  Please specify what those factors are and rate them 1-7 as above.
17
Please describe what you think are the main sources of night-time illumination in the area of your residence (you may give several sources)
The following questions ask you about your sleeping habits. On work days...
18
Do you, or have you ever, undertaken shift work?
Clear selection
19
I get up at....
Time
:
20
I need _________minutes to wake up
21
I regularly wake up.....
Clear selection
22
I am fully awake from.... o' clock
Time
:
23
At around ............ I have an energy dip
Time
:
24
On nights before work days, I go to bed at ....... o' clock
Time
:
25
...and it takes me ......... minutes to fall asleep
26
If I get the chance, I like to take a nap/siesta
Clear selection
27
When I take a nap/siesta, I then sleep for ..............
Hrs
:
Min
:
Sec
On free days (please only judge normal free days, i.e. without parties etc.).....
28
My dream would be to sleep until......... o' clock
Time
:
29
I normally wake up at......... o' clock
Time
:
30
If I wake up at around the normal time of workdays (or alarm time), I try to get back to sleep
Clear selection
31
If I get back to sleep, I sleep for another ........minutes
32
I need ........... minutes to wake up
33
I am fully awake from.........
Time
:
34
at around........... I have an energy dip
Time
:
35
On nights before free days, I go to bed at......... o' clock
Time
:
36
....and it takes me ........minutes to fall asleep
37
If I get the chance, I like to take a nap/siesta
Clear selection
38
If I take a nap, I then sleep for .......... minutes
Thinking of sleeping patterns in general.......
39
Once I am in bed, I like to read for....... minutes
40
but generally I fall asleep after no more than .......... minutes
41
I prefer to sleep in a completely dark room
Clear selection
42
I wake up more easily when morning light shines into my room
Clear selection
43
How long per day do you spend on average outside (really outside!) exposed to daylight during workdays?
Hrs
:
Min
:
Sec
44
How long per day do you spend on average outside (really outside!) exposed to daylight during freedays?
Hrs
:
Min
:
Sec
45
I am...
Clear selection
46
Please give your age
Many thanks for taking the time to complete this survey.
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